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Previous Volume 355:666-674 August 17, 2006 Number 7 Next

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ABSTRACT

Background Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized in infections among persons in the community without established risk factors for MRSA.

Methods We enrolled adult patients with acute, purulent skin and soft-tissue infections presenting to 11 university-affiliated emergency departments during the month of August 2004. Cultures were obtained, and clinical information was collected. Available S. aureus isolates were characterized by antimicrobial-susceptibility testing, pulsed-field gel electrophoresis, and detection of toxin genes. On MRSA isolates, we performed typing of the staphylococcal cassette chromosome mec (SCCmec), the genetic element that carries the mecA gene encoding methicillin resistance.

Results S. aureus was isolated from 320 of 422 patients with skin and soft-tissue infections (76 percent). The prevalence of MRSA was 59 percent overall and ranged from 15 to 74 percent. Pulsed-field type USA300 isolates accounted for 97 percent of MRSA isolates; 74 percent of these were a single strain (USA300-0114). SCCmec type IV and the Panton–Valentine leukocidin toxin gene were detected in 98 percent of MRSA isolates. Other toxin genes were detected rarely. Among the MRSA isolates, 95 percent were susceptible to clindamycin, 6 percent to erythromycin, 60 percent to fluoroquinolones, 100 percent to rifampin and trimethoprim–sulfamethoxazole, and 92 percent to tetracycline. Antibiotic therapy was not concordant with the results of susceptibility testing in 100 of 175 patients with MRSA infection who received antibiotics (57 percent). Among methicillin-susceptible S. aureus isolates, 31 percent were USA300 and 42 percent contained pvl genes.

Conclusions MRSA is the most common identifiable cause of skin and soft-tissue infections among patients presenting to emergency departments in 11 U.S. cities. When antimicrobial therapy is indicated for the treatment of skin and soft-tissue infections, clinicians should consider obtaining cultures and modifying empirical therapy to provide MRSA coverage.

Source Information

From the Department of Emergency Medicine (G.J.M., A.K., D.A.T.) and the Division of Infectious Diseases (G.J.M., D.A.T.), Olive View–UCLA Medical Center, Sylmar, Calif.; and the Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta (R.J.G., G.E.F., L.K.M., R.B.C.).

Address reprint requests to Dr. Moran at the Department of Emergency Medicine, Olive View–UCLA Medical Center, 14445 Olive View Dr., North Annex, Sylmar, CA 91342, or at idnet{at}ucla.edu.

Full Text of this Article

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Therapy for Methicillin-Resistant Staphylococcus aureus
Siegman-Igra Y., Torres-Tortosa M., Caballero-Granado F. J., Canueto J., Jetton L., Cosgrove S. E., Fowler V. G. Jr., Boucher H. W., Moran G. J., Talan D. A.
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N Engl J Med 2006; 355:2153-2155, Nov 16, 2006. Correspondence

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